ABSTRACT
Background: Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation. Methods: This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy.h Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes). Results:162 patients [84 (51·9%) males; mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (log- rank<0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazard- ratio=2·24; adjusted p-value<0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation. Conclusion: HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted.
ABSTRACT
Violence against doctors is on rise throughout the world. Though this violence is more likely to occur in and around intensive care units no doctor is immune to this phenomenon and according to a study by the Indian Medical Association over 75% of doctors have faced violence at work at some or the other time of their career. The doctors are regularly abused, threatened, sued, assaulted, manhandled, and even killed. The phenomenon is rising to such a magnitude that even government hospitals are being guarded by armed security personnel. Even world health origination has taken the cognizance of this situation and drawn out a global action plan to prevent this violence. In absence of any standard operating procedure (SOP) sudden violent events leave everyone clueless and till the time everybody comes into sense the doctors are already brutally assaulted. One of the important steps in prevention of this violence is enactment of law against miscreants. There are instances where some unforeseen complications occur and death of patient results is agitated relatives making complaint against doctors and in many cases, doctors are slapped with IPC 304A for which arrests may take place. Central government as well as many states including state of Rajasthan and Maharashtra have enacted stringent laws against those indulging in violence against health care workers. The need is to implement it properly and law enforcing authorities such as police should be sensitized for using these stringent laws against those who perpetuate violence against health care workers.
ABSTRACT
Systemic sclerosis is a connective tissue disease, which can be triggered by environmental factors. We report one such case of bleomycin-induced scleroderma.